| NPI | 1497915813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 256967) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT186869) |
| 208000000X Pediatrics (Licence: PA mt186869) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2015-05-27 |