| NPI | 1942788302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036160915) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8277) |
| Enumeration Date | 2018-07-29 |
| Last Update Date | 2022-09-08 |