| NPI | 1659618726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2013010102) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2013010102) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: VA 0101051538) | |
| 208D00000X General Practice (Licence: IL 036138557) | |
| 208D00000X General Practice (Licence: VA 0101051538) | |
| Enumeration Date | 2013-01-10 |
| Last Update Date | 2021-01-18 |