| NPI | 1003975863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI EMC0000102) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD431231) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2020-02-18 |