| NPI | 1346330925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023009164) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 43541) |
| 208000000X Pediatrics (Licence: CO 43541) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2023-03-20 |