| NPI | 1134412943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2015-00142) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD451589) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2024-05-23 |