| NPI | 1659592509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 23048) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 23048) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2016-01-06 |