| NPI | 1003174202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA 464135) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA 464135) |
| 207R00000X Internal Medicine (Licence: MI 4301103956) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2021-08-25 |