| NPI | 1962071282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A194664) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.079017) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2026-02-23 |