| NPI | 1164648101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2016-02151) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP612) |
| 208000000X Pediatrics (Licence: KS 6496) | |
| 208000000X Pediatrics (Licence: NC 2016-02151) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-10-12 |