| NPI | 1134112436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 27886) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD31082) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2022-01-28 |