| NPI | 1295047553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.058308) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.068308) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2014-08-19 |