| NPI | 1518923515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036122835) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 31724) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2020-12-29 |