| NPI | 1023019205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q8978) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA 019461) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2021-03-22 |