| NPI | 1346277019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301059747) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301059747) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-01-15 |