| NPI | 1093875494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WY 8429A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2006-0577) |
| 208000000X Pediatrics (Licence: AZ 35845) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2020-12-28 |