| NPI | 1215354360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101272204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101272204) |
| 208000000X Pediatrics (Licence: WI 29618) | |
| 207R00000X Internal Medicine (Licence: WI 69618) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2022-04-12 |