| NPI | 1336176262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 32484) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101263657) |
| 207R00000X Internal Medicine (Licence: VA 0101263657) | |
| 208000000X Pediatrics (Licence: KY 32484) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-11-06 |