| NPI | 1174576730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 019243) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 12805) |
| 208000000X Pediatrics (Licence: VA 0101283243) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2024-11-01 |