| NPI | 1609140490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 266788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 266788) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2016-06-13 |