| NPI | 1497800064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 26824) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME 97642) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-09-03 |