| NPI | 1467541680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 30891) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 50835) |
| 207R00000X Internal Medicine (Licence: WV 30891) | |
| 208000000X Pediatrics (Licence: WI 50835) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-07-24 |