| NPI | 1821202524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME129658) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036117817) |
| 208000000X Pediatrics (Licence: IL 036117817) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2019-11-19 |