| NPI | 1457366056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 323796) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 31448) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2022-08-05 |