| NPI | 1164620464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 53817) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036129518) |
| 208000000X Pediatrics (Licence: IL 036129518) | |
| 208000000X Pediatrics (Licence: MN 53817) | |
| Enumeration Date | 2007-07-07 |
| Last Update Date | 2021-04-29 |