| NPI | 1073826327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125058793) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: IL 036.132209) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2022-02-08 |