| NPI | 1699884247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2020015425) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301088773) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-01-19 |