| NPI | 1578567970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 17310) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-30522) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2022-07-29 |