| NPI | 1508805508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: NC 2009-01748) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2009-01748) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2022-08-02 |