| NPI | 1255623732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 008756) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID O-0862) |
| 208000000X Pediatrics (Licence: WA OP60536051) | |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2023-05-01 |