| NPI | 1952621468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R72115) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R72115) |
| 2080P0205X Pediatrics Pediatric Endocrinology (Licence: PA MT205547) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2014-07-02 |