| NPI | 1467690719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 53611) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-050739) |
| Enumeration Date | 2009-01-24 |
| Last Update Date | 2011-04-15 |