| NPI | 1538130331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 24209) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2011-01675) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2021-07-01 |