| NPI | 1063893733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036150023) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108088) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-04-20 |