| NPI | 1831133693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036106392) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-106392) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2025-07-30 |