| NPI | 1497727374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 42657) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 72992) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2020-08-14 |