| NPI | 1144544669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A111577) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A111577) |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2013-04-05 |