| NPI | 1437576535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 259459) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 259459) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2018-06-25 |