| NPI | 1427289040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 0052597) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 30582) |
| 208000000X Pediatrics (Licence: AL 30582) | |
| 208000000X Pediatrics (Licence: CO 0052597) | |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2015-11-09 |