| NPI | 1053421164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME167637) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 032642) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-04-17 |