| NPI | 1548224637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 3474) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OS012705) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-09-14 |