| NPI | 1124078456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 340047) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME91234) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2024-05-15 |