| NPI | 1508203225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125074845) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OS017238) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2022-06-08 |