| NPI | 1962176081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036172105) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP05414) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2025-10-24 |