| NPI | 1649273228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 006984) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 02189) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2023-06-13 |