| NPI | 1235340605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD29330) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 82687) |
| 208000000X Pediatrics (Licence: OR MD29330) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-11-27 |