| NPI | 1972606028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 43071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 36103342) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2017-02-27 |