| NPI | 1124098728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 100521) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 100521) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2015-01-21 |