| NPI | 1760800676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A154452) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A154452) |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2019-06-07 |