| NPI | 1720207053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 4627) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 6454500-1204) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2016-12-20 |