| NPI | 1144783374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 68528) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 68528) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2025-02-25 |