| NPI | 1811419203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036156731) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036156731) |
| 208000000X Pediatrics (Licence: MA 271799) | |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2021-07-27 |