| NPI | 1487941696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A122325) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A122325) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A122325) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2025-05-06 |