| NPI | 1215257100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD482644) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 60273132) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2024-06-12 |