| NPI | 1831157072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 044432) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 044432) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-03-17 |