| NPI | 1508007659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 53420) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 53420) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2016-01-15 |