| NPI | 1356704647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 314077) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 32463) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2022-12-13 |