| NPI | 1316922875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 14467) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-33553) |
| 208000000X Pediatrics (Licence: IA MD-33553) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2024-04-22 |