| NPI | 1568440428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00033054) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2021-0914) |
| Enumeration Date | 2006-01-02 |
| Last Update Date | 2021-11-10 |