| NPI | 1992213458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.082006) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: IL 17-43161) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2023-06-04 |