| NPI | 1700860103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301059566) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301059566) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-07-08 |