| NPI | 1134110448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-091974) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036091974) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2012-01-03 |