| NPI | 1669508073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 239175) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A126971) |
| 208000000X Pediatrics (Licence: MA 239175) | |
| 208000000X Pediatrics (Licence: CA A126971) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2022-09-08 |