| NPI | 1063643401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA 40357) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301094362) |
| 208000000X Pediatrics (Licence: IA MD-40357) | |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2021-12-01 |