| NPI | 1811999717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G89429) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036088421) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2016-12-07 |