| NPI | 1992789754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 4508) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 45808) |
| 207Q00000X Family Medicine (Licence: WI 45808) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2014-02-27 |