| NPI | 1114990157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME24210) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME24210) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2023-01-24 |