| NPI | 1962697409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 54014) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AK 8157) |
| 208000000X Pediatrics (Licence: MN 54014) | |
| 208000000X Pediatrics (Licence: AK 8157) | |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2018-10-03 |