| NPI | 1215457429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036152425) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2017020356) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-04-18 |