| NPI | 1427578061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A172988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-071406) |
| 208000000X Pediatrics (Licence: IL 125-071406) | |
| Enumeration Date | 2017-06-25 |
| Last Update Date | 2021-09-10 |