| NPI | 1679507198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 42989) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 28955) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-06-28 |