| NPI | 1154513018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 48881) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 48881) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |