| NPI | 1093778797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 052526) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 052526) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-01-07 |