| NPI | 1710244116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NH 19144) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 042.0013145) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2023-03-07 |