| NPI | 1235295551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 023174) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 023174) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2023-06-15 |