| NPI | 1235870627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1027291) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2025-03856) |
| 208000000X Pediatrics (Licence: MA 1027291) | |
| 208000000X Pediatrics (Licence: NC 2025-03856) | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2026-06-22 |