| NPI | 1205196912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2015021635) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C10011901) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2019-05-13 |