| NPI | 1265865133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 54090) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY R4544) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2020-10-29 |