| NPI | 1255593265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 22176) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 30508) |
| 208000000X Pediatrics (Licence: AL 30508) | |
| 208000000X Pediatrics (Licence: MS 22176) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2017-05-01 |