| NPI | 1346637170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 16216) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0029897) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2018-02-22 |