| NPI | 1558821413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023016854) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2023016854) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-09-15 |