| NPI | 1053525584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2009-01423) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 225775) |
| 208000000X Pediatrics (Licence: MA 225775) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2014-11-24 |