| NPI | 1801809124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 19221) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 22832) |
| 208000000X Pediatrics (Licence: AL 22832) | |
| 208000000X Pediatrics (Licence: MS 19221) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2021-05-27 |