| NPI | 1851683122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 55895) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 55895) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2021-05-26 |