| NPI | 1679714216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: IL 036070998) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: IL 036-070998) |
| 207R00000X Internal Medicine (Licence: IL 036070998) | |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2013-12-30 |