| NPI | 1477784213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 53017) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 116798) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2020-08-14 |