| NPI | 1144725946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 56727) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 56727) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2022-07-21 |