| NPI | 1114080991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2004-00565) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2004-00565) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2024-01-26 |