| NPI | 1639437122 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 60536) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 60536) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2021-03-11 |