| NPI | 1699879924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2017-00518) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2017-00518) |
| 207R00000X Internal Medicine (Licence: VA 0101049447) | |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2024-02-28 |