| NPI | 1720217367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 21947) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 21947) |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2016-10-25 |