| NPI | 1003999467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 000000000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 10452) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2019-10-22 |