| NPI | 1063701274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: GA 80622) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL OS12734) |
| 208000000X Pediatrics (Licence: WY 11096A) | |
| 208000000X Pediatrics (Licence: GA 11096A) | |
| 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: FL OS12734) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2018-06-07 |