| NPI | 1912236019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125053694) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2011-1053) |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2015-10-14 |