| NPI | 1811017999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS16049) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 005242) |
| 208000000X Pediatrics (Licence: AZ 005242) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2022-07-19 |