| NPI | 1073704474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2010-01262) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS t2043) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2020-10-26 |