| NPI | 1649858499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.168630) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125077802) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2024-07-02 |