| NPI | 1083619837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 20088031001) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2008031001) |
| 207R00000X Internal Medicine (Licence: KS 0422292) | |
| 208000000X Pediatrics (Licence: KS 04-22292) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2022-07-21 |