| NPI | 1114929122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: ID M-5532) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M-5532) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2016-09-23 |