| NPI | 1922636281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301513705) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301513705) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-10-06 |