| NPI | 1205284775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 58894) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL39437) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2021-03-31 |