| NPI | 1861526790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 26958) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 89586) |
| 208000000X Pediatrics (Licence: SC 26958) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-12-20 |