| NPI | 1891741591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 12953) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 12953) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2010-09-28 |