| NPI | 1346284858 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2008015424) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-43850) | 
| Enumeration Date | 2006-06-15 | 
| Last Update Date | 2023-05-31 |