| NPI | 1174561807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S1143) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301081822) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2019-08-28 |