| NPI | 1952678286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125057310) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 60973) |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2023-01-31 |