| NPI | 1912359605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125069670) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A162719) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2024-06-01 |