| NPI | 1992769863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 0420008428) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 0420008428) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2010-07-20 |