| NPI | 1326571548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72847) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR DO204125) |
| 208000000X Pediatrics (Licence: OR DO204125) | |
| 208000000X Pediatrics (Licence: MN 72847) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2022-11-01 |