| NPI | 1821379512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 16571) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125060327) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2014-10-03 |