| NPI | 1689169591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036155770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072046) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2021-06-11 |