| NPI | 1083665913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 62082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 46812) |
| 208000000X Pediatrics (Licence: WI 46812) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2020-12-02 |