| NPI | 1215303482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125066157) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A155021) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2024-01-10 |