| NPI | 1194106625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 106470301205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL38446) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2018-07-20 |