| NPI | 1568745180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI EMC0003589) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2012-0182) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2023-09-05 |