| NPI | 1184695710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME58404) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME58404) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2024-02-06 |