| NPI | 1861853822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 87360) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MT 87360) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2020-07-01 |