| NPI | 1811685126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036179547) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.082101) |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2026-04-06 |