| NPI | 1306890850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 43101070121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 43101070121) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2021-07-22 |