| NPI | 1528411584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 31429) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7678) |
| 208000000X Pediatrics (Licence: NE 7678) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2020-09-18 |