| NPI | 1548623796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A155519) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A155519) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2019-10-01 |