| NPI | 1700132628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 11883770-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036144791) |
| Enumeration Date | 2012-07-29 |
| Last Update Date | 2022-04-20 |