| NPI | 1386603850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD40831) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD073165L) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2022-10-17 |