| NPI | 1265766026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: UT 8598327-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 8598327-1205) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2021-11-30 |