| NPI | 1598734980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 87846) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR DO29118) |
| 207R00000X Internal Medicine (Licence: IA 02973) | |
| 207R00000X Internal Medicine (Licence: IL 036-088608) | |
| 208000000X Pediatrics (Licence: OR DO29118) | |
| 208000000X Pediatrics (Licence: IA 02973) | |
| 208000000X Pediatrics (Licence: MT 87846) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2024-04-05 |