| NPI | 1225322050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 308691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 262480) |
| 208000000X Pediatrics (Licence: LA 308691) | |
| 208000000X Pediatrics (Licence: MA 262480) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2018-08-13 |