| NPI | 1336670405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0063829) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2020-0556) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2020-07-19 |