| NPI | 1225425143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 66863) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 5735) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2017-02-18 |