| NPI | 1154737468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2017-00607) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY R3505) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-07-21 |