| NPI | 1255386538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-107114) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036107114) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-04-10 |