| NPI | 1205183688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: IL 036.174274) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 179993-30) |
| 207R00000X Internal Medicine (Licence: MO 2021021932) | |
| 163W00000X Registered Nurse (Licence: MO 2021033345) | |
| 207R00000X Internal Medicine (Licence: IL 036.174274) | |
| 208000000X Pediatrics (Licence: IL 036.174274) | |
| 208000000X Pediatrics (Licence: MO 2021021932) | |
| 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: IL 036.174274) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2021040593) | |
| Enumeration Date | 2012-08-05 |
| Last Update Date | 2025-05-09 |