| NPI | 1699842161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 17834) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX J9770) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-11-18 |