| NPI | 1447223193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL 81287) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 81287) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2014-07-21 |