| NPI | 1447320189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 30277) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD424158) |
| 208000000X Pediatrics (Licence: SC 30277) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2013-05-09 |