| NPI | 1922042654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 31144) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 31144) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-09-19 |