| NPI | 1184853749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: PA MD445329) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD445329) |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2020-06-04 |