| NPI | 1588159214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 71408) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 8345) |
| 208000000X Pediatrics (Licence: NE 8345) | |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2022-05-02 |