| NPI | 1962400291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2000157505) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2000157505) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2024-09-03 |