| NPI | 1396778510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 97117) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 9700180) |
| 208000000X Pediatrics (Licence: NC 9700180) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2023-10-13 |