| NPI | 1134353915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A149619) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-35704) |
| 208000000X Pediatrics (Licence: PA MT194741) | |
| 208000000X Pediatrics (Licence: AL MD.32864) | |
| 208000000X Pediatrics (Licence: MO 2012021508) | |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2022-07-21 |