| NPI | 1013216134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 281250) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD453143) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2024-11-05 |