| NPI | 1023421260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 33908) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA OP60658057) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2024-11-21 |