| NPI | 1386819795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2011-00146) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 128761) |
| 208000000X Pediatrics (Licence: NC 128761) | |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2011-02-10 |