| NPI | 1619960465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 00023858) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 00023858) |
| 207R00000X Internal Medicine (Licence: MS 18019) | |
| 208000000X Pediatrics (Licence: MS 18019) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2022-04-27 |