| NPI | 1417044900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 200201312) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 102577) |
| 208000000X Pediatrics (Licence: IL 036.172787) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2025-06-03 |