| NPI | 1609220409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-172537) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01082643A) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2025-01-31 |