| NPI | 1669546255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA OP00002214) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 222085) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2021-06-08 |