| NPI | 1588944201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A119705) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A119705) |
| 207R00000X Internal Medicine (Licence: CA A117705) | |
| 208000000X Pediatrics (Licence: MA 262435) | |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2024-02-16 |