| NPI | 1851592018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 39422) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125050346) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2012-07-30 |