| NPI | 1659639292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101257794) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN17001) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2022-08-10 |