| NPI | 1649700782 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036.156264)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.070733)  | 
| 208M00000X Hospitalist (Licence: IL 036.156264)  | |
| Enumeration Date | 2017-06-12 | 
| Last Update Date | 2022-06-29 |