| NPI | 1619222197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 108385) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301101075) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2019-08-08 |