| NPI | 1336130061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101039103) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: VA 0101039103) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2021-07-31 |