| NPI | 1780761312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: MA 160172) |
| Additional Taxonomies | 207RA0000X Internal Medicine Adolescent Medicine (Licence: MA 160172) |
| 208000000X Pediatrics (Licence: MA 160172) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-09-03 |