| NPI | 1053397984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 9400485) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 94-00485) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2023-03-07 |