| NPI | 1417148891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101259467) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036126164) |
| 207P00000X Emergency Medicine (Licence: KY 44451) | |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2016-07-15 |