| NPI | 1558363168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A52256) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A52256) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2011-07-01 |