| NPI | 1063668341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036127920) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036127920) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2012-11-16 |