| NPI | 1164787321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: LA 310019) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA PGY) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2021-01-11 |