| NPI | 1255330361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-067930) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: IL 036067930) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IL 036067930) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2021-11-29 |