| NPI | 1144456708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 1625) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT012995) |
| 208000000X Pediatrics (Licence: FL OS13349) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2021-09-20 |