| NPI | 1639130180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0054808) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 274742-1205) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-02-04 |