| NPI | 1689635633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME153892) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301088842) |
| 208000000X Pediatrics (Licence: PR 12082) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2024-08-06 |