| NPI | 1760578777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: MA 50614) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 50614) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2012-04-30 |