| NPI | 1700857851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101232718) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2018-02231) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2021-10-29 |