| NPI | 1841238649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 227236) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 227236) |
| 207R00000X Internal Medicine (Licence: IL 036121998) | |
| 208000000X Pediatrics (Licence: IL 036121998) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2026-01-16 |