| NPI | 1962549873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 11977) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 11977) |
| 208M00000X Hospitalist (Licence: PR 11977) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2019-01-18 |