| NPI | 1073777041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A106925) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125051057) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2009-09-04 |