| NPI | 1083152003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD210001407) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT215865) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2021-12-08 |