| NPI | 1497012132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD452724) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 28434R) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2019-08-23 |