| NPI | 1629002282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 67256) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 19378) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-11-07 |