| NPI | 1700873429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101232669) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0059191) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2024-01-24 |