| NPI | 1104898410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 068265) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 22997) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2022-01-07 |