| NPI | 1376938902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 294319) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML 60561474) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2019-03-19 |