| NPI | 1437136785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 3615663) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 47420) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2021-04-26 |