| NPI | 1427103472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD189415) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 31398) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-04-09 |