| NPI | 1134689854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MT230603) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 293035) |
| 207R00000X Internal Medicine (Licence: MA 293035) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-06-24 |