| NPI | 1417577487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-164289) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302041500) |
| 208D00000X General Practice (Licence: MN 70435) | |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2023-09-28 |