NPI | 1609294016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080H0002X (Licence: MA 294008) |
Additional Taxonomies | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: CT 69301) |
208000000X Pediatrics (Licence: CT 69301) | |
2080H0002X (Licence: CT 69301) | |
Enumeration Date | 2014-04-02 |
Last Update Date | 2022-09-14 |