| NPI | 1306836580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2008-00016) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 216779) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2022-10-06 |