| NPI | 1174267645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 348095) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 348095) |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2025-07-25 |