| NPI | 1316258510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-12454) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 101253606) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2023-02-06 |