| NPI | 1376797472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2010-00748) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2010-00748) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2016-01-27 |