| 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 |