| NPI | 1225522410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301506992) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.073250) |
| 207R00000X Internal Medicine (Licence: MI 4301506992) | |
| 208000000X Pediatrics (Licence: IL 125.073250) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2024-07-02 |