| NPI | 1982278842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0103204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.077352) |
| Enumeration Date | 2021-05-16 |
| Last Update Date | 2026-04-16 |