| NPI | 1194722470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 049228) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 049228) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2024-01-26 |