| NPI | 1962437632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 28811) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC TL28811) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-01-12 |