| NPI | 1144414061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2014-00024) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA 437608) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2021-05-06 |