| NPI | 1124463781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 191555) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2016-00299) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2020-10-27 |