| NPI | 1083249775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.078232) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: IL 036.170070) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2026-07-15 |