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 |