| NPI | 1669634820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 51868) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036118405) |
| 208000000X Pediatrics (Licence: IL 036118405) | |
| 208000000X Pediatrics (Licence: WI 51868) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2012-07-10 |