| NPI | 1699950097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A93998) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A93998) |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2015-02-04 |