| NPI | 1760917835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A159720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A159720) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2021-08-09 |