| NPI | 1306111414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 61643) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 61643) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2025-04-08 |