| NPI | 1851615561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D77324) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D77324) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2022-11-21 |