| NPI | 1073595294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2022-00814) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 205195) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2022-08-30 |