| NPI | 1659585156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 51888) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 24998) |
| 207R00000X Internal Medicine (Licence: NE TEP5106) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2026-08-07 |