| NPI | 1740869064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125078075) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125078075) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2021-06-07 |