| NPI | 1255390555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 028136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 028136) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2013-05-31 |