| NPI | 1225012354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 151640) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 151640) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2020-10-30 |