| NPI | 1639757982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX V7587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V7587) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-09-18 |