| NPI | 1053336321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101282743) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD459676) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2024-06-21 |