| NPI | 1417942947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101239136) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2009-01512) |
| 208000000X Pediatrics (Licence: MS 15929) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2021-12-06 |