| NPI | 1528150356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 35072) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200300755) |
| 208000000X Pediatrics (Licence: MD D65480) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-10-08 |