| NPI | 1588788194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD040913) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 20913) |
| 208000000X Pediatrics (Licence: VA 0101252933) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2022-04-20 |