| NPI | 1649539818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 82077) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2017-02273) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2021-05-07 |