| NPI | 1508131939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A129652) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125059635) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2017-01-17 |