| NPI | 1043407174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301092052) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 63590551205) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2023-09-25 |