| NPI | 1457535114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 7696028-1204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R1069) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2024-07-02 |