| NPI | 1821083866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025045328) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-107047) |
| 208000000X Pediatrics (Licence: IL 036107047) | |
| 207R00000X Internal Medicine (Licence: IL 036107047) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2025-10-31 |