| NPI | 1790868008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-059941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-059941) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-05-13 |