| NPI | 1497054662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-43256) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 60029) |
| 208000000X Pediatrics (Licence: IA MD-43256) | |
| 208000000X Pediatrics (Licence: WI 60029) | |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2024-01-11 |