| NPI | 1932462835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 52740) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73468) |
| 208000000X Pediatrics (Licence: AZ R73468) | |
| Enumeration Date | 2012-06-17 |
| Last Update Date | 2021-03-26 |