| NPI | 1427402403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A152897) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A182597) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2022-08-04 |