| NPI | 1407198534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2017-00137) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2017-00137) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2026-07-04 |