| NPI | 1124242409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 065652) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 49059) |
| 208000000X Pediatrics (Licence: KY 41313) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2022-01-10 |