NPI | 1477602209 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 242617) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 242617) |
Enumeration Date | 2007-01-10 |
Last Update Date | 2011-01-27 |