| NPI | 1912900648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 95-00876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9500876) |
| 208000000X Pediatrics (Licence: NC 95-00876) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2020-10-28 |