| NPI | 1104802743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD 034718L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD034718L) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2020-01-21 |