| NPI | 1578739413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2010-00877) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 135200) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2010-06-03 |