| NPI | 1871358754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.084572) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.084572) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-07-01 |