| NPI | 1265521041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 53691) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 105219) |
| 208000000X Pediatrics (Licence: HI MD-6545) | |
| 208000000X Pediatrics (Licence: WI 74424) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-01-29 |