| NPI | 1003879412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 82203) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD425344) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2022-09-23 |