| NPI | 1083639777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 90098) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200201469) |
| 208000000X Pediatrics (Licence: GA 082426) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-09-13 |