| NPI | 1063408235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 9600858) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 9600858) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-10-28 |