| NPI | 1306221346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036148031) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 33133) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2019-02-22 |