| NPI | 1144271602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 13053R) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 13053R) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-04-13 |