| NPI | 1033119441 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01058804A)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01058804A)  | 
| Enumeration Date | 2005-07-28 | 
| Last Update Date | 2022-08-16 |