| NPI | 1477540748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 20825) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 20825) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2022-04-06 |