| NPI | 1306818414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2008-00040) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101234087) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2020-10-28 |