| NPI | 1871550947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 17846) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 17846) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2015-08-18 |