| NPI | 1114901501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036089665) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036089665) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2008-02-22 |