| NPI | 1154398501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200200523) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200200523) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2023-12-27 |