| NPI | 1902608813 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.085586) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.085586) |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-06-16 |