| NPI | 1841391042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-077669) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C187070) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2024-10-30 |