| NPI | 1689872632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P0222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-052756) |
| 208000000X Pediatrics (Licence: IL 125-052756) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2013-06-25 |