| NPI | 1962936047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036152986) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.069830) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2021-01-29 |