| NPI | 1063723708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 4227) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 8606156-1205) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2020-07-21 |