| NPI | 1154636926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 56622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125058493) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2019-06-25 |