| NPI | 1356373500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101271047) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 3704871205) |
| 208000000X Pediatrics (Licence: UT 3704871205) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-03-11 |