| NPI | 1982611521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52186) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-094067) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2015-04-13 |