| NPI | 1962632364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0010489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-056572) |
| 207R00000X Internal Medicine (Licence: DE C2-0010489) | |
| 208000000X Pediatrics (Licence: DE C2-0010489) | |
| 208000000X Pediatrics (Licence: IL 125-056572) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2021-12-03 |