| NPI | 1417937798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD063512L) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: PA MD063512L) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2021-09-24 |