| NPI | 1083947444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2017-00048) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301094762) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2021-06-24 |