| NPI | 1871243873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 17202-I) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 17202-I) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2024-08-19 |