| NPI | 1700449824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036161204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125074616) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-10-23 |