| NPI | 1053607952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 28444) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01081067A) |
| 208000000X Pediatrics (Licence: NY 285562) | |
| 208000000X Pediatrics (Licence: CO CDRH.0057133) | |
| 207R00000X Internal Medicine (Licence: CO CDRH.0057133) | |
| 207R00000X Internal Medicine (Licence: NY 285562) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2021-11-12 |