| NPI | 1912971052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 223458) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 223458) |
| 207P00000X Emergency Medicine (Licence: MA 223458) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2012-10-15 |