| NPI | 1083784862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 200700297) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 11674) |
| 208000000X Pediatrics (Licence: NH 13102) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2023-08-15 |