| NPI | 1275884280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125062369) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME123338) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2020-10-09 |