| NPI | 1174623664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036112147) |
| Additional Taxonomies | 202K00000X (Licence: IL 036112147) |
| 207R00000X Internal Medicine (Licence: WI 61085-20) | |
| 207R00000X Internal Medicine (Licence: OH 35087011) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2022-04-14 |