| NPI | 1003179912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IL 036138298) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125061650) |
| 207R00000X Internal Medicine (Licence: IL 036138298) | |
| 208000000X Pediatrics (Licence: IL 125061650) | |
| 208000000X Pediatrics (Licence: IL 036138298) | |
| Enumeration Date | 2012-06-17 |
| Last Update Date | 2017-05-25 |