| NPI | 1972208627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC LL90433) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL90433) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-07-12 |