| NPI | 1720492689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 277647) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R74468) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2019-06-19 |