| NPI | 1407111396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036131084) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 036131084) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125057650) | |
| Enumeration Date | 2012-07-07 |
| Last Update Date | 2015-07-29 |