| NPI | 1669784930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 22402) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 22402) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2024-03-25 |