| NPI | 1104000397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 048411) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 048411) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2014-08-28 |