| NPI | 1376596296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 17772) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME57291) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2018-03-13 |