| NPI | 1801538632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1026736) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 1026736) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2026-05-24 |