| NPI | 1003341876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 008474) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R2790) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2020-06-11 |