| NPI | 1770804361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: SC 32876) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 32876) |
| 208000000X Pediatrics (Licence: SC 32876) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2021-05-06 |