| NPI | 1114160058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD20941) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 56847) |
| 207R00000X Internal Medicine (Licence: MN 56847) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2025-10-09 |