| NPI | 1205495520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 46739) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 46739) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2023-11-13 |