| NPI | 1255300372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL 142584) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA 476608) |
| 208000000X Pediatrics (Licence: MD D0061888) | |
| 208000000X Pediatrics (Licence: MN 48907) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-05-31 |