| NPI | 1457884561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 21808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.41957) |
| 208000000X Pediatrics (Licence: AL MD.41957) | |
| 208000000X Pediatrics (Licence: NH 21808) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2021-08-06 |