| NPI | 1457317919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 079266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301060183) |
| 208000000X Pediatrics (Licence: MI 4301060183) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2017-11-15 |