| NPI | 1881909596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 84139) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301096993) |
| 208000000X Pediatrics (Licence: MI 4301096993) | |
| 208000000X Pediatrics (Licence: SC 84139) | |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2021-05-11 |