| NPI | 1164782850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NH 17489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME EC121077) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2016-09-08 |