NPI | 1982999801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 270065) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MA 270065) |
Enumeration Date | 2011-06-20 |
Last Update Date | 2017-03-21 |