| NPI | 1063672038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 9386804-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 247128) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2021-12-01 |