| NPI | 1407115538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 60047) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TN 60047) |
| 207R00000X Internal Medicine (Licence: MN 61266) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2020-01-30 |