| NPI | 1518221084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL 117599) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 15759) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2023-12-07 |