| NPI | 1548678527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: IL 125065662) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60753238) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2022-11-16 |