| NPI | 1730364522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036125172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125054064) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2016-02-15 |