| NPI | 1902594567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A207515) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.082256) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2026-07-10 |