| NPI | 1902367766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101027375) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022004128) |
| 207R00000X Internal Medicine (Licence: MO 2019021744) | |
| 208000000X Pediatrics (Licence: MO 2019021744) | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2024-02-23 |