| NPI | 1629450127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-11589) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125066149) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2018-07-10 |