| NPI | 1740633536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1476) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID O-1476) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2023-01-11 |