| NPI | 1528257045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036091753) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 0106111a) |
| Enumeration Date | 2007-10-21 |
| Last Update Date | 2021-12-08 |