| NPI | 1831177146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME111898) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 43110) |
| 208000000X Pediatrics (Licence: VA 0101265587) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2022-11-30 |