| NPI | 1285679704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 36115385) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 44894) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2023-11-27 |