| NPI | 1023251659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 206014) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 206014) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2022-05-24 |