NPI | 1558561282 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61088400) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 2329900) |
208000000X Pediatrics (Licence: WA MD61088400) | |
Enumeration Date | 2007-07-20 |
Last Update Date | 2020-10-09 |