| NPI | 1063530921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 257044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 8736A) |
| 208000000X Pediatrics (Licence: NY 257044) | |
| 208000000X Pediatrics (Licence: WY 8736A) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2023-07-06 |