| NPI | 1801970116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 28546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 28546) |
| 208000000X Pediatrics (Licence: AL 28546) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-03-08 |