| NPI | 1134411564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101273021) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID M-12405) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2021-12-21 |