| NPI | 1699216846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T3139) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 287864) |
| 207R00000X Internal Medicine (Licence: OH 57.029652) | |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: MA T287864) | |
| 208000000X Pediatrics (Licence: OH 57.029652) | |
| 208000000X Pediatrics (Licence: MA 287864) | |
| 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: MA T287864) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-02-03 |