| NPI | 1083097695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125067866) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125067866) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-06-30 |