| NPI | 1851618169 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 55305) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 55305) |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2020-11-10 |