| NPI | 1275658569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 28179) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC MD28179) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2019-07-11 |