| NPI | 1598084717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 85095) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 072564) |
| 208000000X Pediatrics (Licence: SC 85095) | |
| 207R00000X Internal Medicine (Licence: GA 072564) | |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2021-01-05 |