| NPI | 1073520573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 94843) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 5424381-1205) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2023-04-14 |