| NPI | 1215945985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD434483) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-105669) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2012-08-06 |