| NPI | 1083935522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 27855) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011039115) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: NE 27855) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2022-09-09 |