| NPI | 1265052088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 334759) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 334759) |
| 208000000X Pediatrics (Licence: LA 334759) | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2025-09-29 |