| NPI | 1548484140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 33006) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 33006) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2013-08-13 |