| NPI | 1023113941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 291604) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 032395) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2022-07-27 |