| NPI | 1033590773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 65062) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125066888) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2020-05-06 |