| NPI | 1407165079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A118334) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036130801) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2012-10-01 |