| NPI | 1659380467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101233636) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 200400859) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2019-06-28 |