| NPI | 1699834408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME137455) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 38184) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2023-11-11 |