| NPI | 1053601096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 262937) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 262937) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2021-11-11 |