| NPI | 1265449722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-110235) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-110235) |
| 208000000X Pediatrics (Licence: IL 036-110235) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-01-25 |