| NPI | 1518806918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.088311) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.088311) |
| 208000000X Pediatrics (Licence: IL 125.088311) | |
| Enumeration Date | 2026-03-28 |
| Last Update Date | 2026-07-24 |