| NPI | 1710086624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 42260) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 042722) |
| 208000000X Pediatrics (Licence: CA G28462) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2024-08-20 |