| NPI | 1730685215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036159674) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 75593-20) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2026-04-17 |