| NPI | 1700975976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C56003) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C56003) |
| 207R00000X Internal Medicine (Licence: HI 13414) | |
| 208000000X Pediatrics (Licence: HI 13414) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-09-03 |