| NPI | 1992788988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 216938) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 216938) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2007-07-08 |