| NPI | 1174055404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 0065858) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0065858) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-06-30 |