| NPI | 1619012408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 156932) |
| Additional Taxonomies | 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism (Licence: MA 156932) |
| 208000000X Pediatrics (Licence: MA 156932) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |