| NPI | 1205958964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N7244) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME98600) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2021-01-13 |