| NPI | 1831416270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 73620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS12132) |
| 208000000X Pediatrics (Licence: FL OS12132) | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2021-03-09 |