| NPI | 1508881954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301078794) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD439369) |
| 208000000X Pediatrics (Licence: MI 4301078794) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-02-03 |