| NPI | 1962615328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2016-00986) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2016-00986) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2024-07-15 |