| NPI | 1649219585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: SC 23575) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: SC m23575) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2021-02-04 |