| NPI | 1902111412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-01956) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101018779) |
| 208000000X Pediatrics (Licence: MI 5101018779) | |
| 208000000X Pediatrics (Licence: NC 2021-01956) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2022-03-02 |