| NPI | 1336401256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MT 142414) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV DO1964) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2024-06-27 |