| NPI | 1811921729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME83170) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 51888) |
| 207R00000X Internal Medicine (Licence: NC 2011-00027) | |
| 207R00000X Internal Medicine (Licence: AL MD.35392) | |
| 207R00000X Internal Medicine (Licence: AZ 43799) | |
| 208000000X Pediatrics (Licence: FL ME83170) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-05-14 |