| NPI | 1972506160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 48613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036096720) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2018-03-26 |