| NPI | 1700266079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 67426) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 11018250A) |
| 208000000X Pediatrics (Licence: MN 67426) | |
| 208000000X Pediatrics (Licence: IN 01082119A) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2022-11-22 |