| NPI | 1063417731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301088824) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036066835) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2012-02-23 |