| NPI | 1760416242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD429536) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD429536) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2014-11-19 |