| NPI | 1871547505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 36084958) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A50087) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2015-01-20 |