| NPI | 1437387925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 25543) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT195389) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2022-04-15 |