| NPI | 1508916594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NE 20613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 20613) |
| 208000000X Pediatrics (Licence: NE 20613) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2019-08-29 |