| NPI | 1851595912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM A-1522-09) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2007006876) |
| 208000000X Pediatrics (Licence: MO 2007006876) | |
| 208000000X Pediatrics (Licence: NM A-1522-09) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2010-01-07 |