| NPI | 1811929615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME78742) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME 78742) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-10-03 |