| NPI | 1952340143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 62868) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036068517) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2018-01-23 |