| NPI | 1891950606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C175951) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125054577) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2026-01-16 |