| NPI | 1700070067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301102203) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301102203) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2021-03-10 |