| NPI | 1144538323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125054701) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 56060-20) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2012-10-15 |