| NPI | 1669463436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036104057) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2007006527) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2018-07-03 |