| NPI | 1700318557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A169580) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125071132) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2020-08-26 |