| NPI | 1932356763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036142123) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301092065) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2017-01-24 |