| NPI | 1780783670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV WV15579) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: WV 15579) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2009-12-10 |