| NPI | 1073581906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 283683) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD426625) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2020-12-30 |