| NPI | 1427549187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD210274) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 275463) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2023-11-22 |