| NPI | 1871130682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1026435) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 1026435) |
| Enumeration Date | 2019-11-30 |
| Last Update Date | 2026-02-22 |