| NPI | 1457554511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 57404-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036125682) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2015-01-12 |