| NPI | 1720660285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2025-0639) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2025-0639) |
| Enumeration Date | 2021-04-24 |
| Last Update Date | 2025-11-14 |