| NPI | 1396921060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 60225) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD440361) |
| 208000000X Pediatrics (Licence: MI 4301089886) | |
| 208000000X Pediatrics (Licence: PA MD-440361) | |
| Enumeration Date | 2008-01-12 |
| Last Update Date | 2020-12-09 |