| NPI | 1164634531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036.123596) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 25539) |
| 208000000X Pediatrics (Licence: MI 4301083802) | |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2021-03-03 |