| NPI | 1083783245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2015-01843) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 990) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2023-08-15 |