| NPI | 1225569551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-16632) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61058990) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-08-19 |