| NPI | 1245641620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD454886) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C1000) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2020-01-31 |