| NPI | 1114900768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VT 0420010068) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101241744) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2021-04-28 |