| NPI | 1124031067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D95493) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 23943) |
| 208000000X Pediatrics (Licence: VA 0101273165) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2022-12-01 |