| NPI | 1760826408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 50480) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 50480) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2017-08-21 |