| NPI | 1295262723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD482124) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0116030674) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2024-08-15 |