| NPI | 1265926505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC LL52444) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL52444) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2022-07-27 |