| NPI | 1952314114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036111856) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301088197) |
| 208000000X Pediatrics (Licence: MI 4301088197) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2011-08-30 |