| NPI | 1700141819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036137065) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125062110) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2015-08-14 |