| NPI | 1346447919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 30284) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 002418) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2020-10-27 |