| NPI | 1982853974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0081641) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125053922) |
| 207R00000X Internal Medicine (Licence: KY 44662) | |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2016-06-08 |