| NPI | 1194217224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS021279) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT018602) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2021-07-08 |