| NPI | 1043291727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 11270) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NH 11270) |
| 208000000X Pediatrics (Licence: MA 285593) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2024-07-24 |