| NPI | 1639487911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.133495) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 336.094733) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2014-05-23 |