| NPI | 1235279688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 15031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 15031) |
| 208000000X Pediatrics (Licence: MS 15031) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2023-08-30 |