| NPI | 1184625378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101270025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 76350) |
| 208000000X Pediatrics (Licence: MA 76350) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2020-09-24 |