| NPI | 1902808447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 21193) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 21193) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2012-12-10 |