| NPI | 1871172544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E18148) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-18148) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2025-04-30 |