| NPI | 1437354602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 54813-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-8095) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2025-02-24 |