| NPI | 1811258734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-136998) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125:061213) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2023-02-20 |