| NPI | 1538398680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036128279) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010043) |
| 208M00000X Hospitalist (Licence: IL 036128279) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2021-03-25 |