| NPI | 1649244724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2021-00647) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 28673) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2021-03-08 |