| NPI | 1568918753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: AL L.4590) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: IL 125067975) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2018-01-22 |