| NPI | 1508830803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ AZ24143) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: AZ 24143) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2019-01-22 |