| NPI | 1528028149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-44067) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 36388) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2022-08-25 |