| NPI | 1376596254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 19503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 10153958-1205) |
| 208000000X Pediatrics (Licence: AZ 19503) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2022-02-28 |