| NPI | 1326130824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2018-00749) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101036483) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2023-06-22 |