| NPI | 1215319629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 17983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.067767) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: NV 17983) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2019-01-03 |