| NPI | 1316190747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A113347) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125053806) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2021-10-16 |