| NPI | 1518245828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-11028) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q1150) |
| 208000000X Pediatrics (Licence: ME 018864) | |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2018-03-22 |