| NPI | 1073801718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A141619) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R72812) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2021-11-30 |