| NPI | 1962687749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 53010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125050727) |
| Enumeration Date | 2007-12-30 |
| Last Update Date | 2013-07-30 |