| NPI | 1154850477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 70007041204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-10913) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-05-04 |