| NPI | 1871591982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 09731R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 09731R) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2010-11-16 |