| NPI | 1376592956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME82542) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME87304) |
| 208000000X Pediatrics (Licence: FL ME82542) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2012-11-15 |