| NPI | 1790931830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125-050207) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125-050207) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2011-04-06 |