| NPI | 1154559060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WI 66891) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MN 55977) |
| 207R00000X Internal Medicine (Licence: IL 125060767) | |
| 208000000X Pediatrics (Licence: IL 125060767) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2021-05-18 |