| NPI | 1801326095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036155975) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.070456) |
| 208000000X Pediatrics (Licence: IL 125.070456) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-05-19 |