| NPI | 1700129715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL MD.44922) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 27063) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2024-05-09 |