| NPI | 1013051705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-086819) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01041801A) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2021-10-04 |