| NPI | 1235315995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036119123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036119123) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2021-09-14 |