| NPI | 1801243217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 65060) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 65060) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2020-06-05 |