| NPI | 1164443651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 027253) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 027253) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2026-03-16 |