| NPI | 1578524740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 039463) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 039463) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2021-06-25 |