| NPI | 1225011760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 41478) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 41478) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2012-03-01 |