| NPI | 1023223021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.141382) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 200700) |
| 208000000X Pediatrics (Licence: IL 036.141382) | |
| 208000000X Pediatrics (Licence: LA 200700) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2022-05-27 |