| NPI | 1598973778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2009000147) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125050224) |
| 208000000X Pediatrics (Licence: IL 125050244) | |
| 208000000X Pediatrics (Licence: MO 2009000147) | |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2013-06-13 |