| NPI | 1679155063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0116037847) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0116037847) |
| Enumeration Date | 2021-04-25 |
| Last Update Date | 2024-06-04 |