| NPI | 1245253749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 35561) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 15967) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2021-03-29 |