| NPI | 1053306522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 221366) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 077577) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2015-02-05 |