| NPI | 1689088817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA DO-05243) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.064756) |
| 208000000X Pediatrics (Licence: IL 125.064756) | |
| 208000000X Pediatrics (Licence: IA DO-05243) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2018-08-20 |