| NPI | 1639146996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 31337) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 31337) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2024-06-24 |