| NPI | 1609339308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 74655-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 74655-20) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-02-19 |