| NPI | 1346262896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A068315) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A068315) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2024-02-08 |