| NPI | 1447710793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.074248) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 70489) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-04-01 |