| NPI | 1194798777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301080025) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301080025) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2023-03-07 |