| NPI | 1508882341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 269492) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 269492) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 269492) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2019-05-08 |