| NPI | 1417913815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 42025) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 042025) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2022-08-25 |