| NPI | 1568664852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD152064) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 49919) |
| 208000000X Pediatrics (Licence: OR 152064) | |
| 208000000X Pediatrics (Licence: MN 103012) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-10-14 |