| NPI | 1124722855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.082501) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.082501) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2023-07-03 |