| NPI | 1003128109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 272816) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS T-02774) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2021-05-12 |