| NPI | 1780784629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A 10861) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 38920) |
| 208000000X Pediatrics (Licence: CA 20A 10861) | |
| 208000000X Pediatrics (Licence: WI 38920) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2024-04-22 |