| NPI | 1255546941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME156600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 16792) |
| 207R00000X Internal Medicine (Licence: MA 221478) | |
| 208000000X Pediatrics (Licence: MA 221478) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-01-30 |