| NPI | 1619184082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A 113006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301088307) |
| 208000000X Pediatrics (Licence: MI 4301088307) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2021-12-01 |