| NPI | 1174571632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 24487) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MO 2005024068) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2022-08-11 |