| NPI | 1083778765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036124262) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C141874) |
| 207R00000X Internal Medicine (Licence: CA 141874) | |
| 208D00000X General Practice (Licence: CA C141874) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2025-05-13 |