| NPI | 1750359477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 223975) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 223975) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2013-04-08 |