| NPI | 1679102792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102208669) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102208669) |
| 208000000X Pediatrics (Licence: MI 51207R00000X) | |
| 207R00000X Internal Medicine (Licence: MI 515151014352) | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-12-03 |