| NPI | 1972234268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: IL 125.086891) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP05737) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-18 |
| Last Update Date | 2025-06-23 |