| NPI | 1558596668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2015039912) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02003871A) |
| 208000000X Pediatrics (Licence: MO 2015039912) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2022-06-02 |