| NPI | 1124167515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA md448936) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C7-0004080) |
| 208000000X Pediatrics (Licence: DE C7-0004080) | |
| 207R00000X Internal Medicine (Licence: PA md448936) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2014-07-31 |