| NPI | 1083653927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036100573) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 36100573) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2021-12-22 |