| NPI | 1649230962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME82213) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL 0082213) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME82213) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2019-11-22 |