| NPI | 1265679286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101256907) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125051798) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2014-08-19 |