| NPI | 1205904018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301057311) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301057311) |
| 207R00000X Internal Medicine (Licence: MI 4301057311) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2012-08-01 |