| NPI | 1912226580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 100211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD466580) |
| 208000000X Pediatrics (Licence: PA MD466580) | |
| 208000000X Pediatrics (Licence: GA 100211) | |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2025-06-10 |