| NPI | 1174752182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60590269) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125055675) |
| 207R00000X Internal Medicine (Licence: MN 54792) | |
| Enumeration Date | 2009-07-11 |
| Last Update Date | 2016-08-02 |