| NPI | 1336942044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 11116) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 11116) |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-11-20 |