| NPI | 1689080004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD479840) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 66839) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2024-01-25 |