| NPI | 1326466830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0058274) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA 390200000) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-07-21 |