| NPI | 1992149645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-087823) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301047356) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2013-04-24 |