| NPI | 1366617136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2010-00867) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2010-00867) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2021-07-29 |