| NPI | 1386219442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025035556) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2025035556) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2025-09-08 |