| NPI | 1932101284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 39208) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 35889) |
| 208000000X Pediatrics (Licence: KY 35889) | |
| 208000000X Pediatrics (Licence: TN 39208) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2024-02-22 |