| NPI | 1154986404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036168139) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-077739) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2024-09-23 |