| NPI | 1992964167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 253538) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 253538) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2013-02-19 |