| NPI | 1972851145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 39525) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL39525) |
| 207R00000X Internal Medicine (Licence: SC LL39525) | |
| 208000000X Pediatrics (Licence: SC 39525) | |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2024-03-04 |