| NPI | 1083970156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2019-01706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 285139) |
| 208000000X Pediatrics (Licence: NY 285139) | |
| 208000000X Pediatrics (Licence: NC 2019-01706) | |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2024-01-31 |