| NPI | 1740939495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A190703) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A190703) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2026-08-31 |