| NPI | 1184617201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036121326) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 37260) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2020-05-21 |