| NPI | 1275063976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA a164007) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125069955) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2022-06-06 |