| NPI | 1114040516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 61999) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 22580) |
| 208000000X Pediatrics (Licence: WV 22580) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2023-12-11 |