| NPI | 1811133812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A107719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125050566) |
| Enumeration Date | 2008-12-21 |
| Last Update Date | 2012-05-22 |