| NPI | 1104016211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD434099) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD434099) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2020-01-15 |