| NPI | 1548410095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036127222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301092793) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2012-09-05 |