| NPI | 1649533845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2015013976) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125061423) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2015-07-08 |