| NPI | 1174847800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 87497) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 266779) |
| 208000000X Pediatrics (Licence: SC 87497) | |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2024-03-14 |