| NPI | 1275537722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D90260) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD057226L) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2023-03-07 |