| NPI | 1578564928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 9801433) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 98-01433) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-03-07 |