| NPI | 1750586293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2017-01514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-232470) |
| 207R00000X Internal Medicine (Licence: PA MD448242) | |
| 208000000X Pediatrics (Licence: MA 246007) | |
| 208000000X Pediatrics (Licence: PA MD448242) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2017-10-23 |