| NPI | 1710541404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301510242) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301510242) |
| Enumeration Date | 2019-04-28 |
| Last Update Date | 2023-10-16 |