| NPI | 1497277263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-151311) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.071354) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2020-05-04 |