| NPI | 1053707851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 20876) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301500477) |
| 208000000X Pediatrics (Licence: NH 20876) | |
| 208000000X Pediatrics (Licence: MI 4301500477) | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2020-11-05 |