| NPI | 1700238813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036148947) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.069383) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2022-10-21 |