| NPI | 1154557429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036143872) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D77381) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036143872) | |
| 208000000X Pediatrics (Licence: IL 036143872) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2018-01-23 |