| NPI | 1609812981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 51432) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 51432-020) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2021-12-21 |