| NPI | 1679585541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI 19452) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 942768921205) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2024-10-08 |