| NPI | 1194930891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MI 4301085699) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301085699) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2017-12-07 |