| NPI | 1144290552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TN 26795) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 26795) |
| 208000000X Pediatrics (Licence: VA 0101259182) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: VA 0101259182) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2022-05-24 |