| NPI | 1700240751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 68802) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 68802) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2026-08-24 |