| NPI | 1447484134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2013-00371) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2013-00371) |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2021-05-06 |