| NPI | 1356521314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036121705) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-050605) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2011-10-25 |