| NPI | 1831518372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D97649) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD462366) |
| 208000000X Pediatrics (Licence: PA MD462366) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2024-02-07 |