| NPI | 1467905091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 282545) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 282545) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2021-11-22 |