| NPI | 1629299680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200800375) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 200800375) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2012-08-16 |