| NPI | 1144637182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 59786) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 275096) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2020-08-19 |