| NPI | 1245976653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-01218) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2025-01218) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2025-05-05 |