| NPI | 1992091417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 80979) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 80979) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: GA 80979) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2018-07-24 |