| NPI | 1891714531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2010018448) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2010018448) |
| 207R00000X Internal Medicine (Licence: IL 036076854) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-05-09 |