| NPI | 1235750506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4351046139) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351046139) |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2024-07-10 |