| NPI | 1912077249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 9090) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 9090) |
| 208000000X Pediatrics (Licence: SD 9090) | |
| 207R00000X Internal Medicine (Licence: WI 46742-020) | |
| 208000000X Pediatrics (Licence: WI 46742-020) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2023-02-14 |