| NPI | 1326243775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 259989) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2012-01245) |
| 208000000X Pediatrics (Licence: MA 259989) | |
| 208000000X Pediatrics (Licence: NC 2012-01245) | |
| Enumeration Date | 2007-06-17 |
| Last Update Date | 2020-11-19 |