| NPI | 1306959895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101057766) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101057766) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2011-06-03 |