| NPI | 1396900510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2012012471) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2012012471) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2014-01-10 |