| NPI | 1740661016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD16584) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD16584) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2019-06-06 |