| NPI | 1114930427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A93674) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-103723) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2021-12-09 |