| NPI | 1306208699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MD486414) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D0100047) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: VA 0101269974) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: DC MD047067) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2024-11-19 |