| NPI | 1154855542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 77040) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OS020705) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2024-08-15 |