| NPI | 1629091798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 032317) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: CT 032317) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-06-22 |