| NPI | 1952302465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-069747) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036069747) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2012-01-30 |