| NPI | 1053605592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 50795) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 50795) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2024-05-08 |