| NPI | 1922412600 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301106108) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301106108) | 
| Enumeration Date | 2014-06-20 | 
| Last Update Date | 2025-07-11 |