| NPI | 1881867380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0012684) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315031780) |
| 207R00000X Internal Medicine (Licence: NH 15129) | |
| 208000000X Pediatrics (Licence: NH 15129) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2018-07-11 |