| NPI | 1386058923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 50458) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL37060) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2021-03-10 |