| NPI | 1114213691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 49302) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 11968682-1205) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2020-10-13 |