| NPI | 1770233991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2026-02521) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2026-02521) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-07-31 |