| NPI | 1811027675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S8516) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME114981) |
| 207R00000X Internal Medicine (Licence: FL ME114981) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2023-07-07 |