| NPI | 1457465098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036124010) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038007490) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2021-11-18 |