| NPI | 1811358930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A168305) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A168305) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2022-07-29 |