| NPI | 1942595202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 33717) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 33717) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2015-06-29 |