| NPI | 1235199795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA 024980) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 024980) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2016-02-29 |