| NPI | 1174804389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A117840) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A117840) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2021-08-20 |