| NPI | 1619232998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 82156) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102203687) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2019-12-05 |