| NPI | 1497712921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 30044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 30044) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2018-02-06 |