| NPI | 1962666347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CA A128324) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A128324) |
| 208000000X Pediatrics (Licence: AZ 44784) | |
| 208000000X Pediatrics (Licence: AZ R70178) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2024-04-28 |