| NPI | 1750960837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS22178) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS22178) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2025-11-04 |