| NPI | 1346982162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.178282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 74217) |
| 208000000X Pediatrics (Licence: TN 74217) | |
| 208000000X Pediatrics (Licence: IL 036.178282) | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2026-06-30 |