| NPI | 1972703858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 39647) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036128788) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2022-12-20 |