| NPI | 1568800340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-140187) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301103112) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2017-02-01 |