NPI | 1649405226 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60342809) |
Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60342809) |
208000000X Pediatrics (Licence: OK 27107) | |
Enumeration Date | 2009-05-26 |
Last Update Date | 2024-01-04 |