| NPI | 1174555130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD H0090196) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI DO00935) |
| 208000000X Pediatrics (Licence: PA OS007778L) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-02-07 |