| NPI | 1700856960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: AZ 50709) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME88776) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME88776) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2018-07-24 |