| NPI | 1609981661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD46115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 228760) |
| 208000000X Pediatrics (Licence: MA 228760) | |
| 208000000X Pediatrics (Licence: TN MD46115) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2022-03-02 |