NPI | 1700306925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25IB12638200) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 8047) |
207R00000X Internal Medicine (Licence: TX T1597) | |
208000000X Pediatrics (Licence: TX T1597) | |
208000000X Pediatrics (Licence: NE 8047) | |
208000000X Pediatrics (Licence: NJ 25IB12638200) | |
Enumeration Date | 2017-06-20 |
Last Update Date | 2025-08-26 |