| NPI | 1750655643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 72160-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD467682) |
| 207R00000X Internal Medicine (Licence: MI 4301107467) | |
| 208000000X Pediatrics (Licence: WI 72160-20) | |
| 208000000X Pediatrics (Licence: MI 4301107467) | |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2023-06-27 |