| NPI | 1285667394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME107800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2005021705) |
| 208000000X Pediatrics (Licence: MO 2005021705) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2015-03-30 |