| NPI | 1104844455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 026403) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 026403) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-01-08 |