| NPI | 1770147191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 74940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 74940) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2023-07-28 |