| NPI | 1568750933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME149568) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 9889) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2022-11-01 |