| NPI | 1417178518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 236375) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125046473) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-11-03 |