| NPI | 1679003180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A178127) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 272711) |
| Enumeration Date | 2017-06-16 |
| Last Update Date | 2023-10-03 |