| NPI | 1457456873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60109054) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 1184) |
| 208000000X Pediatrics (Licence: NV 1184) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2011-09-06 |