| NPI | 1730705849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301517782) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301517782) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2026-07-13 |