| NPI | 1174624761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 56450) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 52805) |
| 208000000X Pediatrics (Licence: WI 43671) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: MN 56450) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-09-18 |