| NPI | 1457791113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036150828) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01075859A) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2021-06-07 |