| NPI | 1255905782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 81282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 81282) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2025-08-13 |