| NPI | 1629015227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2000-00573) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2000-00573) |
| 208000000X Pediatrics (Licence: NC 2000-00573) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2012-11-06 |